INSULIN:

I. Rapid Acting Insulin ( Clear ) = gives

midmorning weakness /trembling*Covers Insulin Needs for Meals Eaten = at the
Same Time as the Injection.
1. Lispro ( Humalog) = SQ
Rapid Acting
O = Onset : 5 15 min. ( rapid onset =
administer immediately before meals)
P = Peak : 1 3 hours
D = Duration : 3 - 5 hours
2. Aspart ( Novolog) = SQ
Rapid Acting
O = Onset : 5 15 min. ( rapid onset =
administer immediately before meals)
P = Peak : 1 3 hours
D = Duration : 3 - 5 hours
3. Apidra ( Glulisine) = SQ
Rapid Acting
O = Onset : 5 15 min. ( rapid onset =
administer immediately before meals)
P = Peak : 1 3 hours

D = Duration : 3 - 5 hours
Nursing Care = Because Quick Onset of Action
= Client Must Eat Immediately.
Mix only with = NPH ( Humulin-N) or
Ultralente ( Humulin-U)/
If Mixing = Rapid Acting:
Lipsro/Aspart/Apidra : Drawn Up into
Syringe 1st &
Administer Immediately.
II. Short Acting Insulin ( Clear)
*Covers Insulin Needs for Meals Eaten = within
30 60 minutes.
Regular Insulin ( Humulin R , Novolin
R) = SQ, IV
Short-Acting
O = Onset : 30 min. 1 hr ( administer = 30
60 min. before meals)
P = Peak : 2 4 hours
D = Duration : 6 8 hours
Nursing Care = Only Regular Insulin can be
Given IV*.
Regular = Can be Mixed with All Insulin.
If Mixing = Short Acting: Regular Drawn
Up into Syringe 1st & Give Immediately

III. Intermediate-Acting Insulin ( Cloudy) =

gives early evening fatigue.
*Covers Insulin Needs for about = Half the Day
or Overnight.
1. NPH ( Humulin N , Novolin N) = SQ
Intermediate Acting
2. Lente ( Humulin L , Novolin L) = SQ
Intermediate Acting
O = Onset : 1 2 hours. (administer = 30
60 min. before meals)
P = Peak : 6 - 12 hours
D = Duration : 18 24 hours
Nursing Care = Hypoglycemia Tends to Occur
in Mid-to-Late Afternoon.
NPH & Lente = Can be Mixed with
Regular / Lispro / Aspart / Apidra.
IV. Long Acting Insulin ( Cloudy) = gives
early morning headache & confusion
*Covers Insulin Needs for about = One Full
Day.
Ultralente (Humulin U ) = SQ
Long Acting
O = Onset : 3 6 hours.
P = Peak : 12 16 hours

D = Duration : 24 36 hours
Nursing Care = Slow Onset : m.b. require
readjustment of carbohydrate intake
Prolonged Action: m.b. require more between
meal & bedtime snacks.
Ultralente = Can be Mixed with Regular
Insulin.
-Give Once a Day = at The Same Time Each
Day .
V. Long-Acting Insulin ( Clear)
*Covers Insulin Needs for about = One Full Day
1. Lantus ( Glargine) = SQ
Long Acting
2. Levemir ( Detemir) = SQ
Long Acting
O = Onset : 1 - 2 hours.
P = Peak : Peakless*
D = Duration : 24 hours
Nursing Care = Dont Mix with Any Insulin!*
-Give Once a Day = at The Same Time Each
Day : ( with evening meal or bedtime)
VI. Combination Insulin : NPH + Regular

( Cloudy) = give midmorning reactions

*These Products = Give Twice a Day Before
Mealtime.
1. NPH ( 70U) + Regular ( 30U) = ( Humulin
70/30 , Novolin 70 / 30) = SQ
2. NPH ( 50U) + Regular ( 50U) = ( Humulin
50/50) = SQ
O = Onset : 30 min. 1 hr
P = Peak : 4 12 hours
D = Duration : 24 hours
Nursing Care = Dont Give IV*
Eliminates Problem of Mixing
Different Types.
Side Effects of Insulin:
-Hypoglycemia* = blood glucose drops < 50
mg/dl:
Headache /Fatigue /Changes in Vision /
Dizziness/ Drowsiness/ Confusion / Coma
( coma related to = insulin overdose, caused by
inadequate food intake, excessive
exercise, excessive insulin administration)
-Redness/ Swelling / Itching / Mild Pain = at the
Injection Site

-Allergic Reactions = Rash /Hives/ Difficulty

Breathing / Tightness of Chest
Insulin Uses:
a) Short Acting = DKA / During = Surgery,
Infection, Trauma / Poor-Controlled DM
To Supplement LongerActing Insulin
b) Intermediate - Acting =Maintenance Therapy
c) Long-Acting = Maintenance Therapy in
Clients who Experience Hyperglycemia
during the Night with Intermediate-Acting
Insulin.
*insulin preparations consist mixture of = beef
& pork insulin / pure beef / pure pork /
human insulin ( purest insulin = low antigenic
effect)
Insulin Delivery Devices= Pens Injector/ Jet
Injectors / Pumps / Implantable Devices
a) External SQ Insulin Infusion Pump:
are small , externally worn pagersize
programmable device : continuous

subcutaneous insulin delivery system.

1) Contain = a 3 ml Syringe Attached to a Long
( 42-inch), Narrow-Lumen Plastic
Tubing with either a Needle or Teflon
Catheter at the End.
2) The Needle or Teflon Catheter is Inserted
into SQ Tissue ( usually on the abdomen) &
Secured with Tape or a Transparent Dressing.
3) The Needle or Teflon Catheter Changed =
Every 3 days
4) The Pump is Worn either on a Belt or in a
Pocket = Uses Only Regular Insulin.
( lipsro m.b. prescribed)
5) Pump Delivers:
a) Continual ( Basal Rate ) Infusion of Insulin
by Rate: 0.5 2 U /hr =
delivered continuously throughout the day
& night.
b) Additional Low Doses of Insulin (Bolus
Doses) , which are Administered by a
Patient Prior to Each Meal (injected prior
to eating = by a series of button pushes).
6) The Pump Provides = Flexibility for the
Patient.
The Pump is Worn Continuously & is Not

Disconnected for > than 1 hr at a Time.

7) Most Pumps are Now Waterproof & Can be
Worn during Showers & Swimming.
8) Only Short-Acting ( Regular Insulin) or
Rapid-Acting ( Lispro, Aspart, Apidra)
Can be Used in the Pumps.
b) Jet Injectors:
1) High-Pressure Jet Injection of Insulin into the
Skin = to Avoid Needle Injection
2) Used = in Cases of Needle Phobia
3) Problems with Jet Injectors = Variable Depth
of Penetration, Bruising,
Variable Absorption of Insulin
c) Insulin Pen Injector
1) Contain Insulin = in Prefilled Cartridges,
designed to make injection easier & more
flexible/ eliminate needs for drawing up
insulin from a vial/ special pen injection
needles of small size = less discomfort
2) Useful for Insulin Administration = Away
from Home.
Useful in Children on Multiple Injection
Regimen.

istration of insulin

jections by syringe
usually given into
deep SC tissue
ough a two-finger
ch of skin at a 45
angle
e pinch of skin is used
avoid the risk of
ministering insulin IM
e SC fat layer should
thicker than the
edle length. Very
ort needle lengths

g. 5 or 8 mm) are
w available in some
untries and they are
rticularly useful for
ung, slim children
suspensions of insulin
g. NPH, IZS, prexes) must be
uspended before
ection by rolling or
erting the vial or pen
ector device (10
es) so that the cloudy
spension mixes
roughly and
formly
n injector technique
quires careful
ucation including the
ed to ensure that no
ock or blockage forms
the needle; a wait of
10 seconds after

shing in the plunger

ps to ensure complete
pulsion of insulin
ough the needle

ection
st children over the
e of 10 years either
minister their own
ections or help with
m
unger children sharing
ection responsibility
h a parent or other
e provider may help
prepare the device or
p push the plunger
d subsequently under
pervision be able to
rform the whole task
ccessfully
unger children on
ltiple injection
gimens may need help

nject sites that are

icult to reach (e.g.
ttocks) to avoid
ohypertroph

xing of insulin
a mixture of two
s is drawn up = it is
mportant that there is
ntamination of one
with the other in the
To prevent this the
ng principles apply:

nsulin (short-acting)
wn up into the syringe
cloudy insulin
mediate- or long)
cloudy insulin is lente
the mixture must be
istered immediately
wise the short-acting
onent interacts

nd lente insulins
d never be mixed
cting insulin analogs may
d in the same syringe as
lente

syringes
Gauge = 25 26
es are available in a
y of sizes in different
ies and should enable
ate dose delivery, but
esirable for small
1 unit per mark
es (e.g. 0.3 ml) to be
ble for small children
fixed-needle syringes
signed for single use
n syringes must
a measuring scale
stent with the
n concentration
U 100 syringes)

s must never be shared with

person because of the risk
ring blood-borne infection
patitis, HIV)

Injection Sites = SQ (upper arms/ thighs /

abdomen ) & IV ( only regular)
a) Rotate Injection Sites = to Prevent
Lypodystrophy ( Tissue Atrophy &
Hypertrophy)
b) Insert Needle = at 45 or 90 degree angle
( depending on amount of adipose tissue)
Storage of Insulin :
-Store Unopened Vials = in Refrigerator
-Store Opened Vials = at Room Temperature for
1 month
Label Vial with Date & Time Opened or due to
Expiration Date
-Should be at Room Temperature = Before
Injection.
Complications of Insulin:
1. Hypoglycemia = Caused by Insulin

Overdose. Treatment = Administer Glucagon.

2. Lypodystrophy ( Tissue Atrophy &
Hypertrophy) , Caused by:
a) Administration of Cold Insulin
b) from Poor
Rotation of
Injection Sites

3. Somogyi Effect: physiologic effect.

-occurs when a person takes long-acting insulin.
- when blood glucose drops during sleep ( at
night) = that cause release of hormones:

growth hormone, cortisol & catecholamines

=they trigger the liver to release of
glucose into the blood stream = to elevate
blood glucose level.
the body overcompensate = releasing a large
amount of glucose , which cause
rebound effect = causing hyperglycemia in
the morning.
a) Nighttime Hypoglycemia , which Leads to =
Rebound Hyperglycemia in the Early
Morning Hours.
This may Happen Anytime during Sleep, but
Low Blood Glucose:
Hypoglycemia Usually Occurs = around 2 - 3
AM , Followed Hyperglycemia :
Elevation of Blood Glucose = in the Morning.
Cause = Having Too Much Insulin in the
Body Before Bedtime /Long Acting Insulin/
Not Having a Bedtime Snack / Low Blood
Sugar at Night .
SS = Night Sweats / Insomina / Morning
Headache
b) Treatment = Adjusting the Insulin Dose by
Decreasing the Evening Insulin* /
Increasing the Bedtime Snack*(protein snack:

toast with peanut butter,cottage cheese)

Instruct Patient = Check Blood Glucose at
Night: between 2- 3 AM*
4. Dawn Phenomena : physiologic effect
-results due to reduce tissue sensitivity to
insulin. ( increase resistance to insulin)
a) Prebreakfast Hyperglycemia* =Elevation of
Early Morning Blood Glucose
between 2 8 AM due to Nocturnal Release of
GH ( trigger the liver to release of
glucose into the blood stream & elevate blood
glucose level)
-blood glucose steadily elevates through the
night=between 2 -3 AM & time to wake up
b) Treatment = Administer an Evening Dose of
Intermediate-Acting Insulin at 10 PM*./
Use Insulin Pump: to Administer Extra
Insulin during Early Morning Hours* /
Limit of Bedtime Snack*( eat protein snacks
& limit carbohydrates) /
Exercise Later in the Day/
Increase Dose of Oral Hypoglycemic Drugs (
Type-2) or Insulin ( Type-1)
Instruct Patient = Check Blood Glucose at
Night : between 2- 3 AM*

#If the Blood Glucose Level is Low at 2 3 AM

= Somogyi Effect
# If the Blood Glucose Level is Normal or High
at 2 3 AM = Dawn Phenomen
#Difference Dawn Phenomen from Somogyi
Effect that =
Hyperglycemia is Not Triggered by Overnight
Hypoglycemia.
** When Administering Any Insulin =
Hypoglycemic Reaction is Most Likely Occurs
During Peak Action Hours*. A Snack will
Prevent a Hypoglycemic Reaction.
**Hormone that Counteract Insulin =
Glucagon / Epinephrine / Cortisol / GH (Growth
H)
5. Insulin Resistance = Pt develops Immune
Antibodies that Bind the Insulin
Treatment = Administer Purer Insulin ( ex =
human)
**How to Draw Up & Administer a Mixed
Dose of Insulin ( Regular + NPH):
#Use Insulin = at Room Temperature (Avoid
Administer Cold Insulin)

#Draw Up Insulin = Using Sterile Technique*

**When Drawing Up Both : Regular ( R) &
Intermediate ( N) Insulin =
Draw up into the Syringe the Regular 1st
** If Intermediate ( N) Acting Insulin is Ever
Injected into the Vial of Regular ( R)
Insulin = the Entire Vial Needs to be
Discarded!
-Before Administering Insulin = Ensure that
Patient Blood Glucose is Appropriate to the
Insulin Dose to be Administered.
-Check the Label of Insulin Vials/Confirm Dose
of Both Types/ Check Expiration Date.
1. Wash Hands
2. Mix Long-Acting Insulin = Gently Roll
Vial of NPH Insulin Between Palms of
Hands or Gently Invert (Turn) Bottle Slowly
Up & Down (Dont Shake )
3. Cleanse the Tops (Rubber Stopper) of Both
Insulin Vials= with Alcohol Pads, Let Dry
4. Draw Up Air into the Syringe, Equivalent the
Amount of Long-Acting Insulin ( NPH)
to be Administered & Inject Air into the
Long-Acting Insulin ( NPH) Vial .
5. Draw Up Air into the Syringe, Equivalent the

Amount of Short -Acting Insulin(Regul)

to be Administered & Inject Air into the
Short-Acting Insulin(Regular ) Vial.
6. Turn Bottle Upside Down = Make Sure
Needle is Covered with Insulin.
Draw Up Regular Insulin into the Syringe
7. Check for & Remove Any Bubbles from
Regular Insulin = by Tapping Syringe &
Injecting Air Back into Vial.
8. Then =Withdraw the Needle & Carefully
Insert the Needle into Long-Lasting ( NPH)
Vial (make sure needle is covered with
insulin)& Draw Up NPH Insulin into Syringe.
9. Choose & Cleanse the Injection Site with
Alcohol .
Gently Pinch Up Tissue = to Pull Fat Away
from Muscle.
10. Insert Needle ( Full Length ) at 45 90
degree angle into SQ Tissue.
(45 degree = for thin patients, 90 = for thick
patients.)
Inject Slow, Release the Pinched Skin &
Remove Needle ( pull the needle straight out
by holding the syringe by the barrel)
11. Apply Gentle Pressure = Dont Massage the

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